Gopichandran Vijayaprasad
Department of Community Medicine, Employees State Insurance Corporation Medical College and Post Graduate Institute of Medical Sciences and Research, Chennai, India.
Asian Bioeth Rev. 2019 Apr 3;11(1):69-80. doi: 10.1007/s41649-019-00083-5. eCollection 2019 Mar.
The Ayushman Bharat (Hindi for "India blessed with a long life") scheme is a government health insurance program that will cover about 100 million poor and vulnerable families in India providing up to INR 0.5 million per family per year for secondary and tertiary care hospitalization services. In addition, it also proposes to establish 150,000 health and wellness centers all over the country providing comprehensive primary health care. The beneficiaries of the hospital insurance scheme can avail health care services from both public and empanelled private health facilities. This scheme is one of the largest government-sponsored health insurance schemes in the world. Previous experience with government-financed health insurance schemes in India has shown that they are inequitable, inefficient, and do not provide financial protection. There is a lack of clarity on the budgetary provisions over the years when the utilization is likely to increase. The Ayushman Bharat scheme in its current form strengthens the "for profit" private health sector, requiring greater emphasis on its regulation. The scheme, which has primary, secondary, and tertiary care components, places a great focus on the secondary and tertiary care services and requires more investment in comprehensive primary health care. The potential problems of "profit-motivated" supplier-induced demand by private health care providers and corrupt practices are possible ethical burdens of the scheme. For the Ayushman Bharat to meet the ethical principle of justice, it should first address universal coverage of comprehensive primary health care and move on to hospital insurance in a progressive manner. The scheme should have provisions to strictly regulate secondary and tertiary care hospitalization in the private health sector to prevent misuse. It is the ethical responsibility of the government to ensure a strong and robust public health system, but the current provisioning of the Ayushman Bharat scheme does not do this and the reasons for this are explained in this paper.
阿育吠陀·巴拉特（印地语意为“印度享有长寿之福”）计划是一项政府医疗保险计划，将覆盖印度约1亿贫困和弱势群体家庭，每年为每个家庭提供高达50万印度卢比用于二级和三级护理住院服务。此外，该计划还提议在全国建立15万个健康和 wellness 中心，提供全面的初级卫生保健。医疗保险计划的受益人可以从公立和加入医保的私立卫生机构获得医疗服务。该计划是世界上最大的政府资助医疗保险计划之一。印度此前政府资助医疗保险计划的经验表明，这些计划不公平、效率低下，且无法提供经济保障。多年来，在使用率可能增加的情况下，预算拨款缺乏明确性。当前形式的阿育吠陀·巴拉特计划加强了“营利性”私立医疗部门，需要更加强调对其进行监管。该计划包含初级、二级和三级护理组成部分，高度关注二级和三级护理服务，需要在全面的初级卫生保健方面进行更多投资。私立医疗服务提供者出于“利润动机”导致的需求以及腐败行为等潜在问题可能是该计划的道德负担。为使阿育吠陀·巴拉特计划符合正义的道德原则，它应首先解决全面初级卫生保健的全民覆盖问题，并逐步推进医疗保险。该计划应制定严格监管私立医疗部门二级和三级护理住院服务的条款，以防止滥用。确保建立强大而健全的公共卫生系统是政府的道德责任，但阿育吠陀·巴拉特计划目前的拨款并未做到这一点，本文对此原因进行了解释。
